Abstract

A variety of measures of mental health have been used with youth. The reason for choosing one scale over another in any given situation is rarely stated, and cross-cultural validation is scarce. Psychometric testing is crucial before utilizing any measure of mental health with a certain population, due to possible cultural variations in interpreting meaning. The research reported herein describes the development and psychometric testing of the Arab Youth Mental Health Scale. The process included 5 phases: (1) reviewing existing scales leading to the identification of 14 non-clinical and relatively short mental health scales used previously with youth; (2) rating the scales by the researchers and community members leading to the identification of 3 scales with apt structure, and that were judged to be suitable, applicable, and appropriate; (3) soliciting youth input to assess comprehension of each item in the selected 3 scales and to discover context specific mental health related feelings, thoughts, and expressions; (4) seeking expert opinion to classify items remaining after phase 3 that measured common mental disorders, and to limit repetitiveness; and (5) testing for psychometric properties of the 28 items that remained after the previous 4 phases. The contribution of each phase to the process is described separately. Results of the exploratory principal component analysis resulted in one factor which explained 28% of the variance and for which 21 items loaded above an eigenvalue of 0.5. No other factor added significantly to the explanation of variance, nor had items that added theoretical or conceptual constructs. The process of soliciting feedback from youth groups, the community and professionals; and of field testing was challenging; but resulted in a contextually sensitive, culturally appropriate and reliable scale to measure mental health of youth. We recommend that researchers measuring mental health of youth critically analyze the relevance of existing scales to their context; consider using the AYMH scale if appropriate to their target population; and when needed, use a similar methodology to construct a relevant, culturally and contextually sensitive measure.

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Acknowledgments

This paper was produced in the framework of a larger, inter-disciplinary research project on Urban Health, coordinated by the Center for Research on Population and Health at the Faculty of Health Sciences, American University of Beirut, Lebanon, with generous support from the Wellcome Trust, Mellon Foundation, and Ford Foundation.

The authors would like to thank Dr. Trudy Harpham for her valuable guidance in reviewing earlier drafts of this paper, and Tanya Salem for her help with the development of the diagram.

The authors would also like to thank the community and youth of Burj El Barajneh Palestinian refugee camp in Beirut as well as Drs. Hassen El Amin, Brigitte Khoury, Tima El Jamil, and Madeleine Badaro.

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